AB1385 SUBOPTIMAL IDENTIFICATION AND MANAGEMENT OF NON-NOCICEPTIVE TYPES OF PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS REGARDLESS THE ACTIVITY STATUS
Authors: F. Berghea, R. Bratu, N. Cristina, A. M. Spoeala, T. Dogaru, A. Dinoiu, A. Mihailescu, C. Boromiz, E. Juganaru, A. Constantinescu, V. Zanfir, D. Mardale, A. Doran, M. Duna, V. Vlad, M. Abobului, M. M. Negru, I. Saulescu, C. Cobilinschi, C. Constantinescu, D. Mazilu, A. Borangiu, S. Daia-Iliescu, L. Groseanu, D. Opris-Belinski, D. Predeteanu, V. Bojinca, D. Zaharia, A. Trandafir, A. Balanescu
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Pain represents one of the main clinical symptoms of Rheumatoid Arthritis (RA) being used as an indicator of disease activity. However, many RA patients reports clinically significant levels of pain even in the periods of remission. Recent studies [1] revealed that biological treatments are inequal in terms of how they manage inflammation and pain. The concept of Post-Remission Syndrome was defined in the context presence of residual pain in RA patients that are in clinical remission but still present clinical symptoms that impairs their quality of life [2]; the syndrome might be a reason for decreased work productivity [3,4]. Apart of the nociceptive pain previous works identified neuropathic and nociplastic pain in the composition of residual pain. In order to better understand and manage this situation is paramount important to identify and explain the exact nature of pain present during and after the periods of activity in RA. <h3>Objectives</h3> The present study intended to explore the quality of pain assessment and management in subjects with RA in a major tertiary clinic. <h3>Methods</h3> In a major tertiary clinic of rheumatology consecutive subjects with RA have been questioned about the history, evolution and management of their disease; separately the level of nociceptive, neuropathic and nociplastic (fibromyalgic) pain was evaluated by using validated instruments. For a better understanding of the differences, we included and compared subjects with osteoarthritis and other inflammatory rheumatic diseases. <h3>Results</h3> 43 subjects have been evaluated in a 6 months interval with a 2:1 F:M ratio; 22 of them received biological therapy (8 different molecules have been identified). Although 32 subjects did not present any sign of inflammation 21 of them declared significant level of pain (VAS&gt;4), 12 have identified with neuropathic pain and 11 with nociplastic pain. Both in case of neuropathic and nociplastic pain groups less than 50% have been previously actively evaluated for non-nociceptive pain. Non-nociceptive pain was poorly treated and prolonged anti-nociceptive pain treatment was used despite evident lack of effect. The variable ability of pain reduction of biological DMARDs has not been previously discussed with any subject; the subject of residual pain was also poorly covered during biological drug selection. <h3>Conclusion</h3> Non-nociceptive pain has the potential to be considered a major reason of residual pain in RA and non-RA subjects. Rheumatologists seems to be captured in the paradigm of nociplastic = inflammatory pain with little interest in other types of pain that results in suboptimal diagnostic and management of pain. <h3>References</h3> [1]Taylor PC, Lee YC, Fleischmann R, Takeuchi T, Perkins EL, Fautrel B, Zhu B, Quebe AK, Gaich CL, Zhang X, Dickson CL, Schlichting DE, Patel H, Durand F, Emery P. Achieving Pain Control in Rheumatoid Arthritis with Baricitinib or Adalimumab Plus Methotrexate: Results from the RA-BEAM Trial. J Clin Med. 2019 Jun 12;8(6):831. doi: 10.3390/jcm8060831. [2]Berghea F, Berghea CE, et. al. - Residual Pain in the Context of Selecting and Switching Biologic Therapy in Inflammatory Rheumatic Diseases. Front Med (Lausanne). 2021 Aug 17;8:712645. doi: 10.3389/fmed.2021.712645. [3]Putrik P, Ramiro S et.al. -Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries. Ann Rheum Dis. 2019 Nov;78(11):1472-1479. doi: 10.1136/annrheumdis-2019-215294. [4]Suzanne M.M. Verstappen, et. al Considerations for Evaluating and Recommending Worker Productivity Outcome Measures: An Update from the OMERACT Worker Productivity Group, The Journal of Rheumatology Oct 2019, 46 (10) 1401-1405; DOI: 10.3899/jrheum.181201 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Florian Berghea Speakers bureau: Angelini, Pfizer, Richter Gedeon, Egis, Novartis, Roxana Bratu: None declared, Nita Cristina: None declared, Ana-Maria Spoeala: None declared, Tiberiu Dogaru: None declared, Andreea Dinoiu: None declared, Andrei Mihailescu: None declared, Catalina Boromiz: None declared, Elena Juganaru: None declared, Alexandra Constantinescu: None declared, Violeta Zanfir: None declared, DENISE MARDALE: None declared, Aida Doran: None declared, Madalina Duna: None declared, Violeta Vlad: None declared, Mihai Abobului: None declared, Maria Magdalena Negru: None declared, Ioana Saulescu: None declared, Claudia Cobilinschi: None declared, Cosmin Constantinescu: None declared, Diana Mazilu: None declared, Andreea Borangiu: None declared, Sanziana Daia-Iliescu: None declared, Laura Groseanu: None declared, Daniela Opris-Belinski: None declared, Denisa Predeteanu: None declared, Violeta Bojinca: None declared, Dumitru Zaharia: None declared, Andreea Trandafir: None declared, Andra Balanescu: None declare.d.